Psychiatry's New Bible

The month of May marks the release of the DSM-5, the fifth edition of the American Psychiatric Association's best-selling Diagnostic and Statistical Manual of Mental Disorders. Because most insurance providers require a DSM diagnosis as a prerequisite for paying for treatment, the changes in the manual will affect health care for millions of Americans. Here are a few of the major revisions.

New Additions

Hoarding. No longer just a symptom of obsessive-compulsive disorder, research has revealed that the inability to throw away useless items is a malady in its own right.

Gambling disorder. The newest and most controversial member of the “Substance-Related and Addictive Disorders” chapter, compulsive gambling is now officially treatable as an addiction.

Disruptive mood regulation. Until now, kids who are regularly hostile or aggressive were often given the controversial diagnosis of bipolar disorder. Critics worry that giving the symptoms a new name will not solve the real problem: medicating children with drugs never meant for developing brains.

Out with the Old

Asperger's syndrome. The diagnosis and its popular perception—intelligent, single-minded, socially awkward—are a mark of pride for some self-titled Aspies. Now their symptom profile has been folded into the much broader “autism spectrum disorder.”

Sex addiction. Although the term “sex addiction” has not been in the manual since 2000, hypersexuality still warranted a diagnosis of “sexual disorder not otherwise specified.” Now the idea that excessive sex is an illness is gone from the book completely.

Proposed and Rejected

Attenuated psychosis risk syndrome. This proposed disorder was meant to identify children and teens at risk of psychotic disorders, but the model faced criticism over its mediocre ability to predict who will actually develop full-blown psychosis. The syndrome has been relegated to a chapter on conditions that require further research [see “At Risk for Psychosis?” by Carrie Arnold; Scientific American Mind, September/October 2011].